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Colby v. Union Sec. Ins. Co.

United States Court of Appeals for the First Circuit

January 17, 2013, Decided

No. 11-2270

Opinion

 [*59]  SELYA, Circuit Judge. This cutting-edge case involves the existence vel non of an obligation to pay long-term disability (LTD) benefits under a conventional group insurance plan. The central question is whether, in an addiction context, a risk of relapse can be so significant as to constitute a current disability. Although we recognize that our decision creates a circuit split, we answer this question  [*60]  affirmatively and uphold the district court's award of LTD benefits to the plaintiff. In our view, a risk of relapse into substance dependence — like a risk of  [**2] relapse into cardiac distress or a risk of relapse into orthopedic complications — can swell to so significant a level as to constitute a current disability.

I. BACKGROUND

Between 1988 and 2004, the plaintiff, Dr. Julie Colby, was a partner in a medical practice known as Merrimack Valley Anesthesia Associates (MVAA). In that capacity, she served as a staff anesthesiologist at a hospital located in Newburyport, Massachusetts. Her schedule was demanding: she worked 60 to 90 hours per week.

The landscape changed dramatically in July of 2004, when a colleague happened upon the plaintiff "sleeping or unconscious" on a table in the hospital. The plaintiff tested positive for Fentanyl, an opioid used in her anesthesiology practice. As matters turned out, she had for some time been self-administering opioids and had become addicted.

The consequences of this discovery were stark: within a matter of weeks, the plaintiff took a leave of absence and entered inpatient substance abuse treatment at the Talbott Recovery Campus (Talbott) in Atlanta, Georgia. Talbott professionals diagnosed the plaintiff as having an opioid dependence, a dysthymic disorder, and obsessive-compulsive personality traits. In  [**3] addition, her intake examination revealed severe back pain associated with degenerative disc disease and a history of major depression.

The plaintiff stayed at Talbott until November of 2004, after which she remained under regular medical supervision on an outpatient basis. For aught that appears, she has not resumed her use of Fentanyl. Her license to practice medicine was first relinquished, then revoked.

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705 F.3d 58 *; 2013 U.S. App. LEXIS 1149 **; 56 Employee Benefits Cas. (BNA) 1469; 2013 WL 174419

JULIE COLBY, Plaintiff, Appellee, v. UNION SECURITY INSURANCE COMPANY & MANAGEMENT COMPANY FOR MERRIMACK ANESTHESIA ASSOCIATES LONG TERM DISABILITY PLAN, Defendant, Appellant. ASSURANT EMPLOYEE BENEFITS; FORTIS BENEFITS INSURANCE COMPANY, Defendants.

Subsequent History: Judgment entered by Colby v. Union Sec. Ins. Co., 2013 U.S. App. LEXIS 1398 (1st Cir., Jan. 17, 2013)

Prior History:  [**1] APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MASSACHUSETTS. Hon. William G. Young, U.S. District Judge.

Colby v. Assurant Emple. Benefits, 818 F. Supp. 2d 365, 2011 U.S. Dist. LEXIS 117751 (D. Mass., 2011)

Disposition: Affirmed.

CORE TERMS

relapse, benefits, disability, district court, opioid, plan administrator, addiction, substance abuse, accommodation, categorical, claimant, return to work, anesthesiologist, conditions, occupation, coverage, regular occupation, capricious, insistence, disorder

Pensions & Benefits Law, Judicial Review, Standards of Review, Abuse of Discretion, General Overview, ERISA, Civil Litigation, Reasonable Expectations, Business & Corporate Compliance, Disclosure, Notice & Reporting, Benefits Information, Causes of Action, Suits to Recover Plan Benefits, Remedies, Equitable Relief, Handling of Claims, Damages, Costs & Attorney Fees, Discretionary Fees